I am due in few weeks: Is pushing as horrifying as they say?

Dear doctor, I am carrying my first pregnancy and I am getting increasingly anxious about delivery. I have gotten mixed advice leading me to contemplate delivery by Caeserean Section. Which is the best mode of delivery?

Ann,

Dear Ann

Many first time mothers-to-be have genuine concerns about delivery. The availability, of sometimes very subjective advice, from different quarters doesn’t help the situation.

The first thing to understand is that labour and vaginal delivery are completely natural phenomena. During pregnancy, the body goes through various biological adaptations. These changes occur in virtually every organ’s system, but more specifically in the pelvis.

Eventual adjustments in the pelvic muscles, joints and the birth canal finally enhance the spontaneous expulsion of the baby during birth. After delivery, biological healing processes kick-in, leading to the return of normalcy, that in many ways is indistinguishable from the initial pre-pregnancy state.

But nature doesn’t always get it right. Many things can go wrong during pregnancy, and in labour. Some complications will mean that an alternate mode of delivery must be sought. Hence the emergence of the Caesarean Section and the less talked about assisted vaginal deliveries with appropriate instruments.

CS deliveries have increasingly been compared with vaginal deliveries in terms of safety for both mother and baby. The debate rages on whether one is superior, and whether maternal choice can prevail in situations where there is no medical reason for a CS.

Towards the end of the pregnancy, a decision about the mode of delivery must be made. If your pregnancy was uncomplicated, the default advice is to await the onset of labour and anticipate spontaneous vaginal delivery.

The safety of vaginal delivery is proven. All that is required is appropriate monitoring to safeguard any eventualities. If there was however a complication that mandates delivery by CS, then this would be advised in advance.

What about maternal choice? This has come up over the years, riding on arguments about autonomy and choice, and also from observed medical benefits following CS deliveries. There are also arguments against CS deliveries purely on maternal preferences, ranging from cost to surgery-related complications. But there is ample leeway for either camp, necessitating some medical jurisdictions to facilitate CS deliveries by choice.

The eventual decision on how to deliver is guided by several factors. If making a choice for a CS without any medical reasons, have a candid discussion with your gynaecologist. Be very clear about your reasons for choosing a CS. Maintain some flexibility, and be ready to change your mind once you listen to the counter arguments. The overriding goal is safe delivery of your baby. 

- Dr Alfred Murage is a consultant obstetrician and gynaecologist